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o Studies confirm that adults who were unable to move through the tasks of grieving as children are at significant risk for developing depression and anxiety o In our society today it is still difficult to speak about death openly, yet, by age 16 the majority of children will have experienced the loss of a loved one

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Sudden Death (ex. Accident) Capacity to cope is diminished Loss is disruptive so recovery is almost always complicated Cannot comprehend what has transpired Try to reconstruct the death in our minds to allow for some anticipation Grief symptoms tend to persist longer Anticipatory Death (ex. Disease) Have opportunity to say goodbye If healthy anticipation of death will have a better bereavement experience Three time frame losses; past, present and future

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Death is only one form of loss which stimulates the grieving process…. What are some other forms of loss/change which children can be exposed to?

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1) Children do not grieve 2) Children experience few losses 3) Children recover quickly from grief 4) Predictable stages of grief children go through 5) Children who experience bereavement will become maladjusted adults 6) Children should not attend funerals 1) Children may not verbalize feelings more likely to act out through behaviour and play 2) Losses doesn’t always refer to death 3) Adults may not have the energy and knowledge to help children cope with loss 4) Adults want to protect children 5) Grief is intertwined with developmental process 6) No two people are alike 7) Child who receives compassionate care and early interventions can heal and grow from bereavement 8) Funerals provide structure for people to comfort one another, can mourn openly and mourn deceased

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Worden(2002) suggests thinking of mourning in terms of tasks instead of stages: 1. Accept the reality of the loss 2. Work through the pain of grief 3. Adjust to the new environment in which deceased is missing 4. To emotionally relocate the deceased and move on with life

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To accept the reality of the loss developmental age is a major factor AgeReality 3 – 5lack of understanding of finality of death 5-9Death is personified and can be avoided or controlled 9+Understand permanency as well as own vulnerability-everyone dies

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Experiencing the emotions  Being able to express feelings, worries, fears, etc. related to the loss is critical.  Children age 5 – 9 at highest risk for issues as they are beginning to understand the permanency of death, but lack the social/emotive skills to deal with the intensity of feelings attached.  Prone to phobias, nightmares, separation anxiety, etc.

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To adjust to the world without the deceased. Impacted by:  The stability of the remaining caretaker  If the surviving parent is the mother  The amount of environmental change due to the loss  The degree to which life style changes.

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To find a role for the deceased person in one’s life and to find ways to remember:  Being allowed to have memories  Being able to talk about the person who died  Having rituals/ceremonies which include the person who died

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Young children often re-experience mourning process as they move through different developmental stages or life events. Such as:  Puberty  Additional losses  Can conceptually understand death  Reminder of person/thing lost

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. “The risk of major depression is 7 times greater for early adolescents after the death of either parent than for their non-bereaved peers (Gersten, Beals, Kallgren, 1991)  The risk of depressive symptoms for bereaved adolescents 12 to 15 years of age was found to be twice that of children 8 to 11 years, with girls at twice the risk of boys, (Gersten, Beals, Kallgren, 1991)  About one third of the bereaved children experienced serious emotional and/or behavioural difficulties at some point during the 2 years following a major loss.

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 Most children returned to the same level of functioning pre-death (83%) without intervention  Those who didn’t often had a series of additional stressors after or at the time of the death  Bereavement itself was less stressful than theattending events e.g. poverty, moving, mental illness, change of financial status.

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 Nearly all children who attended (the funeral), felt good about what had gone on at the funeral. ( Child Bereavement Study)  57% of children maintain a connection by speaking with their deceased parent, dropping to 39% in the first anniversary (Child Bereavement Study)  74% of children reported the deceased parent was in heaven (Child Bereavement Study)  94% of children thought about their dead parent several times a week 4 months after the loss. After 2 years this was still at 65% (CBS)

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1. How available are support systems at the time the death occurred? 2. How open is the family communication? 3. How much is the home able to provide the essential environmental conditions? Safety Unconditional Love/Acceptance Consistency and Predictability Belonging Opportunity

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4. How easy is it for family members to express their feelings with each other? 5. How easy is it for members to talk about death and the person who died? 6. How reliant were family members on the deceased person?

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7. How much will the life situation change because of the death? 8. What other life circumstances follow the death? (other deaths, move, change of schools, etc.)

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It has been found that the most effective coping tool is communication and expressing the thoughts and feelings related to the death. The better the communication within the family the more healthy. When surviving parent is mother, children tend to be able to talk about feelings more. As well, there tends to less change of routines and daily living patterns. When the surviving parent is the father it is helpful to consider supporting these two areas.

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There are several common questions that children ask/worry about. 1. Why did the person die? 2. Was it my fault? 3. What will happen to me/us now? 4. Will I die? 5. Did my parent know I love them?

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 Lying  Not being emotionally present  Not validating feelings  Using words to soften death

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 Avoidance of child  Avoidance of the death  Not noticing warning signs of need for help  Not giving time  Giving too much time  Treating the child differently than others

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 Fear and anxieties are addressed – to know they will be cared for  Reassurance they are not to blame  Active Listening  Labeling and validation of their feelings  Assisting with overwhelming feeling  Involvement and inclusion  Continued routine activities  Modeled grief behaviors  Opportunity to remember the deceased person

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 Providing wrong information  Withholding information about the event  Not relating the facts as more information becomes available  Not explaining certain facts  Not answering children’s questions about an event  Hiding feelings or not explaining feelings for children  Not talking about or signaling to the child that they should not to bring up the event in conversations  Excluding children from rituals and (re) visiting the scene of the event (ACCP Paper No.17. Dyregrov A. 2001)

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 Give time…don’t rush  Support use of a transitional object  Create a memory book  Go through photos, videos  Remember events, funny stories  Confirm that they will be okay  Tell the truth  Validate all feelings  Have similar expectations  Ask if they are okay (over 10 years)

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 Help to identify/label feelings  Use puppets to talk  Have a ceremony  Plant a tree  Visit the graveyard  Put a message in a helium balloon  Create a prayer  Celebrate birthday, anniversary, Christmas and other important days

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There are many tools and activities that can be used to assist in the Bereavement Process.

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 Use a ball or balloon that you are able to write on.  Using an indelible ink pen write a number of questions related to death and bereavement.  Add about 6 fun or “easy” things to do.  Throw the ball. Whatever question the catcher’s right thumb is closest to they can read out and answer.

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 Create set of cards with questions, (Talk, Story, Wish, Problem Solving, Feelings)  Using a game have a card drawn each time a person talks a turn.

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 Create a Feeling Wheel with the child/youth or family  Have at least 4 feelings if children are 5 and under. Generally take the average age of the children to a maximum of 12 feelings.  Have the children/family decorate the wheel and use to help identify and talk about feelings.

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Felt Boards can be purchased or created very easily. Have the child show what they are feelings through using the felt board to put up different scenes.

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This activity is helpful to identify what is still the same and what has changed. It can also help to identify where they may be some worry about depression/difficulty coping Create a list of common things that a person experiences every day/week in life. (ie sleep, eating, time with friends) Create three headings: Same – More – Less Have the person sort the items under each of these. Note if there are a number of important areas which are in the more or the less list. This could be an early warning sign for depression.

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Many children will talk with or to puppets much more easily than talking with an adult. When using puppets make sure you have several different types and have them close by so the child can use one as well.

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This is a easy tool to use to quickly get a sense of how much of a feeling a person has and which are more troublesome. Use three cups or containers and have something that can represent feelings such as sand, marbles, peas, etc. Help the person to identify all of the feeling associated with the issue you are trying to address. Put all positive feelings in one. Have them pick three feelings that they are having the most of and put one feeling on each of the containers. Have them fill each container to represent how much of that feeling they have.

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Ask the child/person to create a memory book of the person who died. Depending on their age you can be more guiding, such as helping with headings. Use magazines, stickers, drawings, etc. to help depict the memories. Categories that can be helpful: Something funny, What we liked to do together, favorite foods, favorite places, etc.

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There are many books written specifically for children who are grieving, or experiencing certain problems. - The Worry Bag

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Using sand can be very therapeutic for children, youth and adults. Have a tray with sand and a number of miniatures, animals, people, trees, vehicles, etc. Ask the child to show you what their world is like: - Before the person died - After the person died - What is it like at home - What is it like with friends - How is the family feeling, etc.

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For older children, over 9, journaling can be helpful. This entails the child/youth writing down their thoughts each day. This could be just before bed, or first thing in the morning. It is important that this be treated confidentially unless the child decides to share.